Organization
PRESTIGE PRIMARY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA KATHERINE TABOR NP (OWNER)
(337) 804-2049
Entity
Organization
Contact information
Practice address
2851 JOHNSTON ST, LAFAYETTE, LA 70503-3243
(337) 281-6102
(877) 866-3181
Mailing address
2851 JOHNSTON ST, LAFAYETTE, LA 70503-3243
(337) 281-6102
(877) 866-3181
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP04615
LA
Other
Enumeration date
07/08/2015
Last updated
07/08/2015
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